Staying Independent...Together

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   RE: Income and expenses and lifestyle
 From: Mamatha Agrawal
 To: Member Forum
 Posted: 10-29-2017 16:34

I think we're all about the same and nothing has change in the last 15 years. There is this mirage and promise of switching to value based care and that the metrics/PCMH we are furiously trying to measure and report are going to yield something.
We are currently still at volume based care.
As IMPs we chose to cut our volume and pay for flexibility and balance in our life.

The "average" and recruitment salaries that are often posted no doubt come with the volume to support it. We could all answer an ad, potentially sell or integrate our practices or take an employed position if we wanted to.
Employed positions may give us higher salaries but we will either be patient mill or chain gang. It seems like more and more the employed positions don't push on volume but focus on process, metrics and quality and downstream revenue from having primary care patients in the system.

If we want to increase our salaries, we will need to see the same old 80-110 patients per week that was required of us years ago or we have to have an alternate revenue stream.

$80K on Mike S is thus far the highest for 24-28 patients per week.

I need to see 35-55 patients per week to make that.
I agree with Mike B overhead about 60% for this low volume.

My rent is $3750 per month going up to $4000 and I probably chose a space that is too large for me, but I still like it. I did the 1200 sq. foot office for 3 years and wanted to upgrade. I have 3 years left on my lease but I might consider integration with a hospital if it is offered to me (congrats Dr. Oaks). I did provide health insurance and good hourly pay to 3 employees (including myself) in 2017 but not sure what will happen to health insurance next year. Practice Fusion is free and my billing that I personally do through NueMD is about $200-$225 per month
I, too, have a part-time NP as of this year and take all my own call.
We do our own cleaning!!! Ugh. Roomba it is. 

Mamatha Agrawal, MD
Family Doctor CaryNC
Cary, NC
Live in Raleigh, NC
Solo since 2012
Practice Fusion and NueMD
Original Message:
Sent: 10-22-2017 17:16
From: Michael Barron
Subject: Income and expenses and lifestyle

-$103,000.00 Barrons Salary
-$60,005.00 NP salary
-$13,233.00 Secretary Salary
-$16,695.00 Rent
-$10,667.36 Malpractice
-$1,080.00 Credit Card Processing
-$1,378.26 Office Phone
-$1,333.56 cellphones
-$1,292.75 Updox
-$1,735.98 Sanofi (Vaccines)
-$288.00 ePrescribing (eDoctor)
-$780.00 Internet
-$1,415.25 Gateway EDI (clearinghouse)
-$300.00 IT contractors
$0.00 Conferences
$0.00 Elance Contractors
-$250.00 IMP Membership
-$31,062.67 Other (lazy accounting)

I practice in St. Louis, Missouri.  I take Medicare, commercial and Medicaid.  This was from 2015 which was the last year before my Medicare Advantage payments started happening.  My nurse practitioner works 3 days per week and my secretary is full time.  I get my health insurance through the Army Reserve (Tricare), about $200/month for the family.  It also provides another $10K income on years when I have not deployed.  Both my employees get their health insurance through their spouses.

I worked 5 days a week seeing patients, took call 24/7 all year, rounded on my patients in the hospital, and did admin stuff mostly on the weekends.  I worked 50-60 hours per week.  I took 3 weeks vacation.  This didn't seem like a bad deal at all to me because the pace of my day was pretty relaxed.  I found working 3 12 hour ER shifts per week harder mainly because the pace was much faster and the intermittent night shifts.

Avg visits per day (MD and NP combined): 11-12
Revenue per visit $105
Expenses per visit $60

Michael Barron
Barron Family Medicine
University City MO

Original Message:
Sent: 10-11-2017 15:45
From: Michael Safran
Subject: Income and expenses and lifestyle

I feel this is an elephant in the room and hope we can have more open honest discussion about it.  Most people in IMP recognize the personal rewards and value of being in a small independent practice.   But, unless we can share the possibility of earning a decent living, few will choose that option.

Hopefully, some of us will post their income and expenses.   We will learn from each other about how to save.   How work flow and time per visit affect income.  I have always felt that scheduling two patients per hour keeps me off the treadmill, my overhead is much lower and calls almost non existent.   I see 12 to 14 patients per day.  I was influenced by the Gordon Moore articles years ago.

I recognize it is uncomfortable discussing our income, even humbling when you read the "average income" for FPs and "specialists" that we all see in Medical Economics and other journals.  When I look at recruitment ads for primary care, especially in certain areas of the country, and in large multispecialty groups, I see some starting salaries around $225K plus benefits.

Many years ago, there was a thread on the IMP forum about income and expenses.  I found it helpful.    I have worked to keep overhead low.

I stated in another post that I earned approx $40K per year for each day I work in office.  I currently work 2 days per week in my office, which equates to approx 80K per year earned in my private office.

In fairness, I do work outside my office 1 day per week, and my needs are much less then new grads.   My children are through college, mortgage mostly paid, wife also works, etc., and when I started, most FP grads went into private practice.   So here goes:

Annual expenses = 82K
32 - Employee
15 - Rent  (sublet)
  6 - Malpractice "part- time"
  5 - tel, internet,
  3 - Electric
  3 - billing software
  0 - EMR (PF and paper charts)
  4 - cleaning
  4 - supplies
10  - misc - (computer equip and support, accountant, ins., medical waste, etc )

160K income approx 13.5 per month

I realize all our situations are different but hope others will share info.

Michael S. MD

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